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| Urinary tract infections are a serious health problem affecting millions of people each year. Infections of the urinary tract are common--only respiratory infections occur more often. Each year, urinary tract infections (UTI's) account for about 8 million doctor visits. Women are especially prone to UTI's for reasons that are poorly understood. One woman in five develops a UTI during her lifetime. Causes Normal urine is sterile. An infection occurs when microorganisms, usually bacteria from the digestive tract, cling to the opening of the urethra and begin to multiply. Most infections arise from one type of bacteria, Escherichia coli(E. coli), which normally live in the colon. Microorganisms called Chlamydia and Mycoplasma may also cause UTI's in both men and women, but these infections tend to remain limited to the urethra and reproductive system. Unlike E. coli, Chlamydia and Mycoplasma may be sexually transmitted, and infections require treatment of both partners. At Risk Population Some people are more prone to getting a UTI than others. Any abnormality of the urinary tract that obstructs the flow of urine (a kidney stone, for example) sets the stage for an infection. An enlarged prostate gland also can slow the flow of urine, thus raising the risk of infection. People with diabetes have a higher risk of a UTI because of changes in the immune system. Any disorder that suppresses the immune system raises the risk of a urinary infection. UTI's are unusual in men. They usually stem from an obstruction--for example, a urinary stone or enlarged prostate--or a medical procedure involving a catheter. The first step is to identify the infecting organism and the drugs to which it is sensitive. Usually, doctors recommended lengthier therapy in men than in women, in part to prevent infections of the prostate gland. Prostate infections (prostatitis) are harder to cure because antibiotics are unable to penetrate infected prostate tissue effectively. For this reason, men with prostatitis often need long-term treatment with a carefully selected antibiotic UTI's may occur in infants who are born with abnormalities of the urinary tract that sometimes need to be corrected with surgery. UTI's are rarely seen in boys and young men. In women, though, the rate of UTI's gradually increases with age. Scientists are not sure why women have more urinary infections than men. One factor may be that a woman's urethra is short, allowing bacteria quick access to the bladder. Also, a woman's urethral opening is near sources of bacteria from the anus and vagina. For many women, sexual intercourse seems to trigger an infection, although the reasons for this linkage are unclear. Recurrent Infections Many women suffer from frequent UTI's. Nearly 20 percent of women who have a UTI will have another, and 30 percent of those will have yet another. Of the last group, 80 percent will have recurrences. Usually, the latest infection stems from a strain or type of bacteria that is different from the infection before it, indicating a separate infection. (Even when several UTI's in a row are due to E. coli, slight differences in the bacteria indicate distinct infections.) Symptoms Not everyone with a UTI has symptoms, but most people get at least some. These may include a frequent urge to urinate and a painful, burning feeling in the area of the bladder or urethra during urination. It is not unusual to feel bad all over--tired, shaky, washed out--and to feel pain even when not urinating. Often, women feel an uncomfortable pressure above the pubic bone, and some men experience a fullness in the rectum. It is common for a person with a urinary infection to complain that, despite the urge to urinate, only a small amount of urine is passed. The urine itself may look milky or cloudy, even reddish if blood is present. A fever may mean that the infection has reached the kidneys. Other symptoms of a kidney infection include pain in the back or side below the ribs, nausea, or vomiting. Diagnosis To find out whether you have a UTI, your doctor will test a sample of urine for pus and bacteria. You will be asked to give a "clean catch" urine sample by washing the genital area and collecting a "midstream" sample of urine in a sterile container. When an infection does not clear up with treatment and is traced to the same strain of bacteria, the doctor will order a test that makes images of the urinary tract If you have recurrent infections, I will perform an ultrasound exam in the office, which gives pictures from the echo patterns of soundwaves bounced back from internal organs. Another useful test is cystoscopy. A cystoscope is an instrument made of a hollow tube with several lenses and a light source, which allows the doctor to see inside the bladder from the urethra. Treatment An uncomplicated UTI can be cured with 1 or 2 days of treatment. UTI's are treated with antibacterial drugs. The choice of drug and length of treatment depends on the patient's history and the urine tests that identify the offending bacteria. The sensitivity test is especially useful in helping the doctor select the most effective drug. The drugs most often used to treat routine, uncomplicated UTI's are trimethoprim (Trimpex), trimethoprim/sulfamethoxazole (Bactrim, Septra, Cotrim), amoxicillin (Amoxil, Trimox, Wymox), nitrofurantoin (Macrodantin, Furadantin), and ampicillin. Often, a UTI can be cured with 1 or 2 days of treatment if the infection is not complicated by an obstruction or nervous system disorder Severely ill patients with kidney infections may be hospitalized until they can take fluids and needed drugs on their own. Kidney infections generally require several weeks of antibiotic treatment Various drugs are available to relieve the pain of a UTI. A heating pad or a warm bath may also help. Most doctors suggest that drinking plenty of water helps cleanse the urinary tract of bacteria. For the time being, it is best to avoid coffee, alcohol, and spicy foods. (And one of the best things a smoker can do for his or her bladder is to quit smoking. Smoking is the major known cause of bladder cancer.) Recurrent Infections in Women Women who have frequent recurrences may benefit from preventive therapy. About 4 out of 5 women who have a UTI get another in 18 months. Many women have them even more often. A woman who has frequent recurrences (three or more a year) should ask her doctor about one of the following treatment options:
Dipsticks that change color when an infection is present are now available without prescription. The strips detect nitrite, which is formed when bacteria change nitrate in the urine to nitrite. The test can detect about 90 percent of UTI's and may be useful for women who have recurrent infections. Additional steps that a woman can take on her own to avoid an infection:
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